Myofascial ReleaseWhat is fascia? Fascia is tough connective tissue which spreads throughout the body in a three-dimensional web from head to toe. The fascia is ubiquitous, surrounding every muscle, bone, nerve, blood vessel and organ all the way down to the cellular level, hence the fascial system is not segmented or divided structurally. However, the tissue quality within this single system varies in terms of density and function according to local tensional demands. Fascia is composed of an elasto-collagenous complex with elastin fibers and collagen fibers (both of these are types of proteins), embedded in a gelatinous ground-substance which allows fibers and cells to move without restriction. Ground substance is a gel like consistency of raw egg white. It reduces friction between muscle fibers creating ease of motion. These single collagen molecules line up side by side overlapping in a staggered pattern akin to a brick wall, and they attach together to form a tough stable fabric. Scar tissue is new collagen that is secreted by ground substance, but the viscosity or density of the ground substance can vary from very thick to watery. The thicker the ground substance, the thicker and less mobile the tissue is. The fascia can be simply described as consisting of three layers.
The superficial fascia lays directly under the skin. With long term muscle tightness, the superficial layer loses its mobility and becomes taut. Muscles are embedded in deep fascia; when in the healthy state, this fascia is soft and pliable allowing the muscle fibers to contract and lengthen efficiently. Subserous fascia lines the body cavities and surrounds the organs. It also surrounds blood vessels and nerves, and forms the dural tube which surrounds and supports the central nervous system (brain and spinal cord). What are myofascial restrictions? The moving body depends on connective tissue for support and biomechanically efficient movement. Connective tissues make a major contribution to the dynamic properties of the body. Movement depends on connective tissue being functional and properly distributed. Research has suggested that inflammation, injury, postural stress, and overuse syndromes can cause the fascial tissue to become tighter or denser. In an attempt to support the body, the system contracts and bonds to neighbouring structures forming adhesions which can impair their ability to slide freely over one another. The unwanted bonding can create excessive deposits of tissue resulting in thick bandaging around joints and fibrous masses in the muscle bellies. Myofascial restrictions can create abnormal strain patterns and hold the skeleton in an inefficient alignment, potentially leading to poor muscular biomechanics, altered structural/bony alignment, and pain. Neural and vascular structures can also become entrapped in these restrictions, causing neurologic symptoms or ischaemic conditions. What is myofascial release? The goal of myofascial release is to elongate and soften the connective tissue relieving soft tissue from an abnormal hold of a tight fascia. Myofascial release is a hands-on soft tissue technique that facilitates a stretch into the restricted fascia. A sustained pressure is applied into the restricted tissue barrier; after 90-120 seconds the tissue will undergo histological (microscopic) length changes allowing the first release to be felt. The therapist follows the release into a new tissue barrier and holds. After a few treatments, the tissues can become softer and more pliable, which can help to reduce pain and tissue tenderness, and restore alignment and joint mobility. Self-myofascial release is when an individual uses an object to provide myofascial release under their own power, usually in the form of foam roller, ball or massage stick. An individual rests their body weight over the piece of equipment and uses gravity to induce pressure along the length of the specific muscle or muscle groups, allowing for the fascia to be massaged. There is an array of kit out there, which can be very helpful if used correctly and safely. If it is appropriate, your therapist will recommend products that could help you. Myofascial release is often used in conjunction with other manual therapies and acupuncture, but also with various strengthening and stretching exercises. Interestingly, fascia is also influenced by temperature and emotion so the use of heat and relaxation-techniques may also be recommended by your therapist. As with many musculoskeletal health issues, it is important to identify, treat and then manage the underlying causes of your problem. For example, if you have long-standing neck pain caused by poor posture sitting as your desk, hands-on treatment can help to relive your pain and restore normal movement, however it is also important to address your desk ergonomics; increase your postural awareness; partake in exercises that stretch the compressed tissues and strengthen the muscles to support better posture; and implement strategies that you can do yourself to manage any symptoms you may experience. Having an awareness about fascial tissue can also help in your understanding of how a problem or injury in one area of the body can have a ‘knock-on’ effect onto another area. So many patients comment that they have problems ‘down one side of their body’, or that for example, since they twisted their ankle they are having issues with their lower back. Fascia can be one of the reasons for this, though a thorough assessment will help to identify all contributory factors. This also highlights the importance of rehabilitating properly from an injury or painful condition in order to minimise future problems. Should you wish to discuss this further, please do not hesitate to contact the clinic (01225 683007) or email Renu who has a particular interest in this area (Renu.khosla@physioimupulse.co.uk) Central Bath Physio References:
Barnes, M. F. 1997. The basic science of myofascial release: morphologic change in connective tissue. Journal of Bodywork and Movement Therapies 1(4), pp. 231-238. doi: https://doi.org/10.1016/S1360-8592(97)80051-4 Gordon, C.-M. et al. 2016. Myofascial triggerpoint release (MTR) for treating chronic shoulder pain: A novel approach. Journal of Bodywork and Movement Therapies 20(3), pp. 614-622. doi: https://doi.org/10.1016/j.jbmt.2016.01.009 Grieve, R. et al. 2015. The immediate effect of bilateral self myofascial release on the plantar surface of the feet on hamstring and lumbar spine flexibility: A pilot randomised controlled trial. Journal of Bodywork and Movement Therapies 19(3), pp. 544-552. doi: 10.1016/j.jbmt.2014.12.004 Shah, S. and Bhalara, A. 2012. Myofascial Release. International Journal of Health Sciences & Research 2(2), pp. 69-77. Wong, K.-K. et al. 2017. Mechanical deformation of posterior thoracolumbar fascia after myofascial release in healthy men: A study of dynamic ultrasound imaging. Musculoskeletal Science and Practice 27, pp. 124-130. doi: https://doi.org/10.1016/j.math.2016.10.011
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